Not even the largest medical center in the United States has access to a sufficient number of patients with acute hepatic failure to evaluate controversial or proposed new methods of treatment. The Acute Hepatic Failure Study Group consists of investigators interested in various aspects of the syndrome who have combined for cooperative studies of methods of therapy. Increasing in number from 15 to 20 major medical centers over a two-year period, the Group has been conducting a trial of glucocorticoids in fulminant hepatic disease due to viral hepatitis and to adverse drug reactions. Its evaluation began under a grant (AM 17953) in January, 1975, and will continue through December, 1977. From the beginning of accessions in July, 1975, through December, 1976, and 18-month period, a total of 32 patients were randomized to the three treatment groups: hydrocortisone, 800 mg/day; hydrocortisone, 400 mg/day; and placebo. To obtain the projected number of 100 randomized patients, therefore, the Group proposes a three-year extension. It believes that much will be learned in this way not only about therapy, but also about etiology and natural history. For the latter purpose, essentially the same information and specimens are provided for non-randomized cases, of which there were 37 accesssed in the period mentioned. Special emphasis is now being placed upon an intensive study of hepatitis A and hepatitis B viruses as etiologic agents, using essentially all of the techniques presently available for this purpose. A similar focus upon assay of hormones is of interest, and upon prognostic indices such as alpha-fetoprotein and F protein are planned.